scholarly journals Bariatric Metabolic Surgery Reduced Liver Enzyme Levels in Patients with Non-Alcohol Fatty Liver Disease

2021 ◽  
Vol 14 ◽  
pp. 209-214
Author(s):  
Kennedy Kirkpatrick ◽  
Bobbie Paull-Forney ◽  
Hayrettin Okut ◽  
Tiffany Schwasinger-Schmidt

Introduction. Approximately 93.3 million Americans are obese (BMI>30) and 51% have non-alcoholic fatty liver disease (NAFLD).  Progression of NAFLD can lead to Non-Alcoholic Steatohepatitis (NASH), the leading cause of liver transplant in the United States. This study analyzed liver enzymes following bariatric surgery in NAFLD patients up to one-year post-surgical intervention. Methods. A retrospective analysis of adults with NAFLD who underwent bariatric surgery from 2009 to 2016 was conducted. The primary outcome were transaminase levels following weight loss. Secondary outcomes included effects on blood glucose, lipids, and blood pressure. Results. A total of 130 participants consisting of 80% Caucasian females with an average BMI of 47.5 participated in the study. Reductions were noted in ALT (66.2 to 28.6 units/L) and AST (46.3 to 24.2 units/L) at 1 year post-surgical intervention.  Significant reductions were also noted in blood glucose (22.34%; p < .0001), HbA1c (17.11% p < .0001), LDL (19.75% p = .0046), total cholesterol (10.12% p = .0153), and triglycerides (37.21% p < .0001) with an increase in HDL (17.22% p = .0007). Significant correlations between alkaline phosphatase and ALT were noted at six months (p=.0101) and one year (p= .0547) and AST at six months (p=.0009). When separated by obesity class, participants with class II obesity experienced improved outcomes. Conclusions. Data obtained from this study indicated that bariatric surgery reduces liver enzyme levels in NAFLD. These findings suggest that bariatric surgery is a viable treatment option for participants with NAFLD.

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Young Bin Won ◽  
Seok Kyo Seo ◽  
Bo Hyon Yun ◽  
SiHyun Cho ◽  
Young Sik Choi ◽  
...  

AbstractTo evaluate risk factors leading to non-alcoholic fatty liver disease (NAFLD) occurrence in polycystic ovarian syndrome (PCOS) women. A retrospective cohort study of a total of 586 women diagnosed with PCOS aged 13–35 years at the gynecology department at a university hospital was done to evaluate PCOS phenotype, metabolic syndrome (MetS) diagnosis, body composition, insulin sensitivity, sex hormones, lipid profile, liver function, and transient elastography (TE). In PCOS women with NAFLD compared to those without, MetS diagnosis (Hazard ratio [HR] 5.6, 95% Confidence interval [CI] 2.2–14.4, p < 0.01) and hyperandrogenism (HA) (HR 4.4, 95% CI 1.4–13.4, p = 0.01) were risk factors significantly associated with subsequent NAFLD occurrence, whereas 2-h insulin level in 75 g glucose tolerance test (GTT) (HR 1.2, 95% CI 0.5–2.5, p = 0.70) and body mass index (BMI) > 25 kg/m2 (HR 2.2, 95% CI 0.6–8.0, p = 0.24) was not. Among NAFLD patients who underwent TE, a higher number of MetS components indicated a worse degree of fibrosis and steatosis. MetS diagnosis and HA at PCOS diagnosis were risk factors associated with NAFLD, while 2-h insulin level in 75 g GTT and obesity were not. Although elevated aspartate aminotransferase levels were significant for NAFLD risk, liver enzyme elevations may not be present until late liver damage. Further prospective studies of PCOS women with MetS or HA are warranted to determine whether patients without liver enzyme elevations should undergo preemptive liver examinations.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Andrew Yang ◽  
Melinda Nguyen ◽  
Irene Ju ◽  
Anthony Brancatisano ◽  
Brendan Ryan ◽  
...  

AbstractSignificant weight loss can modify the progression of Nonalcoholic fatty liver disease (NAFLD) with the most convincing evidence coming from bariatric surgery cohorts. Effective ways to non-invasively characterise NAFLD in these patients has been lacking, with high Fibroscan failure rates reported. We prospectively evaluated the utility of Fibroscan using XL-probe over a two-year period. 190 consecutive patients undergoing bariatric surgery were followed as part of their routine care. All patients had Fibroscan performed on the day of surgery and at follow-up a mean of 13 months (± 6.3) later. The majority of patients were female (82%) with mean age of 42. Fibroscan was successful in 167 (88%) at baseline and 100% at follow up. Patients with a failed Fibroscan had higher body mass index (BMI) and alanine transaminase (ALT), but no difference in FIB-4/NAFLD score. Mean baseline Liver stiffness measurement was 5.1 kPa, with 87% of patients classified as no fibrosis and 4% as advanced fibrosis. Mean baseline controlled attenuation parameter was 291, with 78% having significant steatosis, 56% of which was moderate-severe. Significant fibrosis was associated with higher BMI and HbA1c. Significant steatosis was associated with higher BMI, ALT, triglycerides and insulin resistance. Mean follow up time was 12 months with weight loss of 25.7% and BMI reduction of 10.4 kg/m2. Seventy patients had repeat fibroscan with reductions in steatosis seen in 90% and fibrosis in 67%. Sixty-four percent had complete resolution of steatosis. Fibroscan can be performed reliably in bariatric cohorts and is useful at baseline and follow-up. Significant steatosis, but not fibrosis was seen in this cohort with substantial improvements post-surgery.


2016 ◽  
Vol 64 (2) ◽  
pp. S502-S503 ◽  
Author(s):  
Z.M. Younossi ◽  
L. Henry ◽  
M. Stepanova ◽  
Y. Younossi ◽  
A. Racila ◽  
...  

2020 ◽  
Author(s):  
Kasper W. ter Horst ◽  
Daniel F. Vatner ◽  
Dongyan Zhang ◽  
Gary W. Cline ◽  
Mariette T. Ackermans ◽  
...  

<b>Objective</b>: Both glucose and triglyceride production are increased in Type 2 diabetes and non-alcoholic fatty liver disease (NAFLD). For decades, the leading hypothesis to explain these paradoxical observations has been selective hepatic insulin resistance, wherein insulin drives <i>de novo</i> lipogenesis (DNL), while failing to suppress glucose production. Here, we aimed to test this hypothesis in humans. <p><b>Research Design and Methods</b>: We recruited obese subjects who met criteria for bariatric surgery with (n=16) or without (n=15) NAFLD and assessed: i) insulin-mediated regulation of hepatic and peripheral glucose metabolism using hyperinsulinemic-euglycemic clamps with [6,6-<sup>2</sup>H<sub>2</sub>]glucose, ii) fasting and carbohydrate-driven hepatic DNL using deuterated water (<sup>2</sup>H<sub>2</sub>O), and iii) hepatocellular insulin signaling in liver biopsies collected during bariatric surgery.</p> <p><b>Results</b>: As compared with subjects without NAFLD, subjects with NAFLD demonstrated impaired insulin-mediated suppression of glucose production and attenuated -not increased- glucose-stimulated/high-insulin lipogenesis. Fructose-stimulated/low-insulin lipogenesis was intact. Hepatocellular insulin signaling, assessed for the first time in humans, exhibited a proximal block in insulin-resistant subjects: signaling was attenuated from the level of the insulin receptor through both glucose <i>and</i> lipogenesis pathways. The carbohydrate-regulated lipogenic transcription factor <i>ChREBP</i> was increased in subjects with NAFLD. </p> <b>Conclusions</b>: Acute increases in lipogenesis in humans with NAFLD are not explained by altered molecular regulation of lipogenesis through a paradoxical increase in lipogenic insulin action; rather, increases in lipogenic substrate availability may be the key. <a></a>


2015 ◽  
Vol 25 (12) ◽  
pp. 2335-2343 ◽  
Author(s):  
Shinhiti Morita ◽  
Dalísio De Santi Neto ◽  
Flávio Hiroshi Ananias Morita ◽  
Nina Kimie Morita ◽  
Suzana Margareth Ajeje Lobo

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2316
Author(s):  
Suguru Ikeda ◽  
Takaaki Sugihara ◽  
Takuya Kihara ◽  
Yukako Matsuki ◽  
Takakazu Nagahara ◽  
...  

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease related to metabolic syndrome. No standard pharmacological treatment has yet been established. We retrospectively evaluated the efficacy of pemafibrate in 16 NAFLD patients (11 men and 5 women; median age, 59 years; range, 27–81 years) who had taken pemafibrate for at least one year. They were all diagnosed with fatty liver according to imaging and clinical criteria. They were administered pemafibrate from October 2018 to October 2021 (median, 94 weeks; range, 56–157 weeks). Serum triglyceride was significantly decreased by −41.9% (342.3 ± 54.0 to 198.9 ± 20.4 mg/dL, p < 0.001). Aspartate aminotransferase (AST), alanine aminotransferase, and gamma-glutamyl transferase levels significantly decreased by −42.1% (49.6 ± 7.0 to 28.7 ± 3.4 U/L, p < 0.001), −57.1% (65.1 ± 10.8 to 27.9 ± 3.7 U/L, p < 0.001), and −43.2% (68.9 ± 10.9 to 39.1 ± 5.3 U/L, p < 0.05), respectively. The AST to platelet ratio (APRI) (0.8 ± 0.1 to 0.4 ± 0.1, p < 0.001) and fibrosis based on four factors (FIB-4) index (1.8 ± 0.3 to 1.4 ± 0.2, p < 0.05) also significantly decreased. Liver attenuation (39.1 ± 1.2 to 57.8 ± 2.7 HU, p = 0.028) and liver/spleen ratio (0.76 ± 0.04 to 1.18 ± 0.02, p = 0.012) significantly improved in three patients, as assessed by computed tomography. In conclusion, pemafibrate significantly improves serum triglyceride levels, liver function, FIB-4 index, APRI, and fatty liver in NAFLD patients with hypertriglyceridemia.


2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 909-909
Author(s):  
Anna Ssentongo ◽  
Paddy Ssentongo ◽  
Laura Keeney ◽  
Arkorful Ebenezer ◽  
Forster Amponsah-Manu ◽  
...  

Abstract Objectives Non-alcoholic fatty liver disease (NAFLD) is a leading cause of cryptogenic cirrhosis and liver transplant in the United States. It is associated with increased length of stay and poor surgical outcomes. NAFLD affects approximately 30% of American adults, and even more Africans. However reported rates of NAFLD in African countries vary widely, where recent studies have shown that up to 50–87% Africans are could be living with NAFLD. The objective of this study was to estimate the prevalence of NAFLD in Ghana and to assess whether NAFLD is associated with increased length of stay and surgical complications. Methods A prospective study on 96 surgical patients aged 18 and older, without a history of alcohol abuse or liver disease, who presented at Eastern Reginal Hospital in Ghana for elective general and gynecological procedures between September and December 2018. A single, expert radiologist screened all patients for NAFLD using an abdominal ultrasound machine. NAFLD was diagnosed in conjunction with the American Association for the study of liver disease guidelines, assessing for increased hepatic echogenicity compared to the spleen and kidneys. Patients were followed up for 30 days and information was collected on length of stay and surgical site occurrences (SSO). Univariate analysis and multivariable logistic regression were performed using SAS 9.4. Results Of 97 patients, mean age 46 ± 14 years, mean BMI 26.9 ± 7.7, and 40 (42%) Male, the mean length of stay was 2.7 days ± 2.7 days. Eighteen (19%) patients had a length of stay ≥ 5 days and 9 (9%) developed a SSO. Ultrasonography revealed that 54 (56%) of patients had NAFLD, of which 15 (28%) patients had moderate disease (25–50% of liver), and 39 (72%) had mild (5–25%) disease. Diabetes, hypertension, obesity, and BMI were not associated with NAFLD. NAFLD and sex were independent predictors of an increased length of stay ≥ 5 days, where patients with NAFLD were 5x as likely to have an extended length of stay, but not SSO compared to those without NAFLD (OR: 4.8 95% CI 1.1–18.5). Conclusions Ghana has almost twice the prevalence of NAFLD compared to the United States, suggesting that NAFLD is very common in Africa. It is associated with delayed surgical recovery leading to more than twice the average length of stay. Funding Sources None.


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